Mathematical weighting of the pediatric Crohn's disease activity index (PCDAI) and comparison with its other short versions

Dan Turner, Anne M. Griffiths, Thomas D. Walters, Tong Seah, James Markowitz, Marian Pfefferkorn, David Keljo, Jacob Waxman, Anthony Otley, Neal S. Leleiko, David MacK, Jeffrey Hyams, Arie Levine

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

Background: The Pediatric Crohn's Disease Activity Index (PCDAI) has become the standard outcome measure in pediatric Crohn's disease (CD) clinical research. Other versions have been proposed but without systematic evaluation. The aim was to assess validity and responsiveness of the abbreviated PCDAI (abbrPCDAI), short PCDAI (shPCDAI), and modified PCDAI (modPCDAI) as measures of disease activity and to compare these with a mathematically weighted version developed here (wPCDAI). Methods: The raw data from four prospectively collected datasets were used, totaling 437 children with CD (including two clinical trials). Discriminant validity utilized physician global assessment of disease activity (PGA), and construct validity the correlation with PGA and laboratory results. Feasibility and face validity were ascertained by a survey of 33 experts in pediatric CD. Results: The wPCDAI had better performance than the PCDAI in construct validity and responsiveness and it discriminated better between the disease activity categories (area under the receiver operator characteristic [ROC] 0.97; 95% confidence interval [CI]: 0.95-0.99). In comparison to the original PCDAI, the noninvasive versions (abbrPCDAI and shPCDAI) had lower face, construct, and discriminant validity but were judged to be significantly more feasible. The modPCDAI performed well in the construct validation but was consistently inferior in all other parameters. Cutoffs that correspond to remission, response, and gradations of disease activity were determined for each index. Conclusions: The newly weighted wPCDAI performed better than the original PCDAI and is more feasible. The noninvasive versions (shPCDAI and abbrPCDAI) are inferior to the full PCDAI, but when needed in retrospective studies either may be equally used.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalInflammatory bowel diseases
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2012

Keywords

  • clinimetrics
  • Crohn's disease
  • inflammatory bowel disease
  • PCDAI
  • Pediatric Crohn's Disease Activity Index
  • Pediatrics
  • wPCDAI

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

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    Turner, D., Griffiths, A. M., Walters, T. D., Seah, T., Markowitz, J., Pfefferkorn, M., Keljo, D., Waxman, J., Otley, A., Leleiko, N. S., MacK, D., Hyams, J., & Levine, A. (2012). Mathematical weighting of the pediatric Crohn's disease activity index (PCDAI) and comparison with its other short versions. Inflammatory bowel diseases, 18(1), 55-62. https://doi.org/10.1002/ibd.21649